Offer to Purchase and Contract dated
________________ at _____________________ (address) between
______________________ and ____________________________ (Sellers) and
_____________________ and __________________________ (Buyers).

We hereby request the return
of our earnest money in the amount of _______________ ($__________) and declare
the above contract to be null and void.

By signing this request, the
Sellers and the Buyers shall release each other from any and all claims or
liabilities and all parties agree to consider the Contract null and void.